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Published on: May 22, 2019
Testing the vascular depression hypothesis: The role of intracranial atherosclerosis in post-CABG depression (NOAHS
Mark A Oldham1, Patrick Walsh1, Joy J Choi1
1University of Rochester Medical Center, Department of Psychiatry, 300 Crittenden Blvd, Box PSYCH, Rochester, NY 14642, US.
Insights
Middle cerebral artery (MCA) stenosis does not predict depression after coronary artery bypass graft (CABG) surgery. Lower psychosocial support, however, is a significant risk factor for developing post-CABG depression.
Area of Science:
- Neuroscience
- Cardiology
- Psychiatry
Background:
- Depression is a common complication following coronary artery bypass graft (CABG) surgery, linked to poorer patient outcomes.
- The Neuropsychiatric Outcomes After Heart Surgery (NOAHS) study investigates the vascular depression hypothesis in CABG patients.
- This hypothesis suggests cerebrovascular disease contributes to late-life depression.
Purpose of the Study:
- To determine if middle cerebral artery (MCA) stenosis or its severity predicts the risk of developing depression after CABG surgery.
- To examine the association between intracranial atherosclerosis and post-CABG depression.
- To identify predictors of new-onset depression in patients undergoing CABG.
Main Methods:
- Prospective evaluation of non-demented patients aged 40+ undergoing CABG surgery.
- Depression assessed monthly for 12 months post-surgery; baseline assessments included.
- Transcranial Doppler (TCD) used to measure intracranial atherosclerosis, specifically MCA stenosis.
Main Results:
- Of 148 patients (mean age 66.1, 75.7% male), 16% developed new-onset depression after excluding baseline cases.
- New-onset depression was associated with younger age, functional impairment, lower psychosocial support, mild cognitive impairment (MCI), and prior depression.
- No association was found between MCA stenosis (or its severity) and new-onset depression post-CABG.
Conclusions:
- Baseline middle cerebral artery (MCA) stenosis is not associated with new-onset depression after CABG.
- Lower perceived psychosocial support emerged as a significant predictor of post-CABG depression.
- Established risk factors, not cerebrovascular disease markers like MCA stenosis, are key in post-CABG depression.
Background:
Depression after coronary artery bypass graft (CABG) surgery is common and associated with worse outcomes. The Neuropsychiatric Outcomes After Heart Surgery (NOAHS) study evaluates the vascular depression hypothesis, which implicates cerebrovascular disease as a contributor to late-life depression, as applied to a CABG surgery cohort.
Methods:
We evaluate whether right or left middle cerebral artery (MCA) stenosis or its severity is associated with a greater risk of post-CABG depression. NOAHS was a prospective study of non-demented patients 40 years of age or older having CABG surgery. Depression was evaluated at baseline and monthly after surgery to 12 months. Transcranial Doppler (TCD) assessed intracranial atherosclerosis at baseline. We examined whether MCA stenosis predicted new-onset depression, adjusting for baseline characteristics.
Results:
In our sample (n = 148, average age 66.1, 75.7 % male), 11 % had baseline depression and 26 % had mild cognitive impairment (MCI). Perceived psychosocial support was high, with a mean score of 82.7 of 100 on the Medical Outcomes Study social support survey. Excluding those with baseline depression, 13 (16 %) developed new-onset depression. New-onset depression was associated with younger age, greater baseline functional impairment, lower perceived psychosocial support, MCI status, and prior depression. MCA stenosis and its severity was not associated with new-onset depression in any model; however, lower perceived psychosocial support did predict new-onset depression.
Conclusions:
We did not find an association between baseline MCA stenosis and new-onset depression after CABG. Instead, well established risk factors including lower perceived social support were more strongly associated with post-CABG depression.
